Active NPI
Kevin Raymond Johnson I, M.D.
- Surgery Physician
- Oregon City, OR
National Provider Identifier
1750387049
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- MD16564
- Practice address
- 1510 Division St
Ste 210
Oregon City, OR 97045-1599 - Phone
- (503) 723-6525
- Fax
- (503) 723-6508
- NPI assigned
- Jun 22, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | MD16564 | OR | Primary |
| Vascular Surgery Physician | 2086S0129X | MD16564 | OR | |
| Colon & Rectal Surgery Physician | 208C00000X | MD16564 | OR |
Addresses
Primary practice location
1510 Division St
Ste 210
Oregon City, OR 97045-1599
Mailing address
PO Box 3158
Portland, OR 97208-3158
Phone (503) 215-6494
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 128541 | Medicaid | OR | |
| P00924574 | Other | OR | RR MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD16564 | OR | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1119398400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1309132800000",
"number": "1750387049",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3158",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972083158",
"telephone_number": "503-215-6494",
"fax_number": "503-215-6644"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1510 DIVISION ST",
"address_2": "STE 210",
"city": "OREGON CITY",
"state": "OR",
"postal_code": "970451599",
"telephone_number": "503-723-6525",
"fax_number": "503-723-6508"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "KEVIN",
"middle_name": "RAYMOND",
"name_prefix": "Dr.",
"name_suffix": "I",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-22",
"last_updated": "2011-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "OR",
"license": "MD16564",
"primary": true
},
{
"code": "2086S0129X",
"taxonomy_group": "",
"desc": "Surgery, Vascular Surgery",
"state": "OR",
"license": "MD16564",
"primary": false
},
{
"code": "208C00000X",
"taxonomy_group": "",
"desc": "Colon & Rectal Surgery",
"state": "OR",
"license": "MD16564",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "128541",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "P00924574",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oregon City, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.